A bedtime story and a birthweight theory come together.
It was 10 pm. The forest, as always, whirred into life at night. The crickets chattered. Somewhere in the night, an owl hooted. Along with my wife, I was sitting in the portico of the forest bungalow, sipping hot coffee with Lieutenant Rohan Carriappa and his wife, Priya, both our friends. We sometimes visited them at their mountain bungalow during the monsoons, whenever we could take a break from the heavy schedules of work.
Priya, just 24 years old, was 5 months pregnant. She was justifiably anxious, and endearingly excited at the prospect of motherhood. During these days of leisure, the evenings were spent on telling and retelling horror stories. Usually, I was asked to narrate one, given my interest in the occult and the supernatural. The dark, mountainous, forestry and the night made a perfect ambience for this.
Today, however, Rohan and Priya wanted a different story from me. Priya had been reading about pregnancy on the internet, and was surprised to find that the baby got programmed in the mother’s womb. And this programming, she read, could determine almost every aspect of the baby’s health. She was excited, and wanted to know more. And like a fool, I had promised to tell her the story behind all this, only to realize later what a difficult task it would be to explain these things to a non-medical person.
“ A dark, dark concept indeed!” mused Rohan, sipping away at his drink, “ Who on earth would have thought that the mothers womb would set the tone for a lifetime? Come, come, you must tell us this story..”
Even the cloudy night broke into a sweet, expectant drizzle, as if the clouds could wait no more to hear my story. I decided to do an impromptu dramatization. I decided to throw away those hard facts and focus on telling the tale. I decided to enjoy myself in creating this story of part-fact, part fiction. I began ..
“ Almost a century ago, Britain had been suffering from the throngs of the Industrial Revolution. The economy was at an all-time low, and the middle classes in Britain were starving. The Renaissance had come and gone, but the Da Vincis and Michelangelos could hardly feed the world. Sandwiched between two World Wars, Britain’s poor were the most affected. Great Britain was not so great anymore. And the pangs were most acutely felt in Southampton and the nearby areas. Workers in steel mines, coalfields and related industry worked hard.
These workers would work for very little wages, sometimes running into only a few pence. After working for over 15 hours in a day, they would have little time for anything afterwards. They would brawl in the Inns, drink beer till their heads swam and then slept till their next shifts. The women were poorly structured, and looked starved and malnourished. At about that time, Dr Jones (name not changed as the existence of this doctor is purely fictious, I clarify!), a young doctor working tirelessly in for the miners noticed a thing or two about the pregnant women there. The women looked starved,. And when they became pregnant, their eyes took on a deathly pallor that bespoke of malnutrition. Dr Jones had dedicated his life to these miners and their families. He could not help noticing how he and his family too- just because of the heavy poverty that had descended on the times- had started looking as unhealthy as the miners themselves.
And when Dr Jones’s wife, young bonny lass of all but 24 years ( Priya Shuddered) delivered, Dr Jones was stunned to find out that the baby was only 1.3 kgs. Dr Jones checked the records…1.5 kg, 2 kg, 1.3kg, 1 kg, 900 g… he found that not a single child born in the area had an adequate birth weight of 2.5 kgs. For the next one year, Dr Jones would tirelessly collect the names and addresses of all the little babies that were born in the area. His clinic was filled with records of babies, their weights, their parents weights etc. Dr Jones was sure it was nothing to do with smoke or the coal. The low birth weight had everything to do with poverty, lack of food and maternal malnutrition. However, Dr Jones could hardly finish his work. He was stuck with pneumoconiosis, a lung disease that people exposed to coal mines got. One day he coughed out a few liters of blood and breathed his last. His clinic was temporarily shut down…”
I paused, in a typical storyteller style. Indeed, I was feeling guilty for having made up such a story. The story was, of course, based on fact, but the characters were completely fictitious! I paused to look at my audience. Their faces glowed in the light of the fireplace by the verandah. Their faces were eager, rapt with attention. Encouraged, I decided to take the plunge into a second odyssey of fiction. I continued.
“ The place was the same, but the year was 1970 (or was it 1962?). Britain had changed. Riding on the success of World War II and on the fiery speeches of Churchill, and spurred no doubt by Britains closeness to America, England was on a roll. Having woken from its Colonialist dream, the economy was booming. The stock indices were rising, manufacturing was on the increase and people were getting richer. There was plenty to eat and drink all around. In Herefordshire, and other areas near Southampton, a new disease was on the rise. People would eventually call it lifestyle diseases a decade later, and in 1988, it would be called Syndrome X. Simply put, people were getting Syndrome X, which was a constellation of obesity, diabetes, hypertension, high cholesterol. And this syndrome X eventually led to heart attacks.
Back in the areas where Dr Jones had set up his clinic, things were different. There were no coal miners, but people of new-found wealth. People were spending, children were eating, television was “in”. The situation is quite similar to India, with its newfound wealth today. Next to Dr Jones’ now-shut-down clinic was now a huge, modern, county hospital, with lush gardens and a smart-tiled roofs and floors. The hospital offered stat-of-the art facilities for the local community. The patients walking in no longer had tuberculosis or lung disease, but instead, died of diabetes, hypertension and heart attacks. The old and dead Dr Jones’ son Simon was now working there as a physician. He, like his father had an intuitive mind, and noticed a very odd thing. The people who were getting diabetes and hypertension and heart attacks were all children born to the miners of the city. Their wealth had grown, but Simon could see that the diseases went beyond the simple explanation of prosperity-induced diseases. Simon remembered his mother saying something about his father having made a list.
One night, Simon sought out Dr Jones office and traced out all the names of the children born to miners- the children with low birth weight, whose addresses the old Dr Jones had so diligently recorded just before his death.
Simon traced out and tested each and everyone of the low birth weight babies, who were all grown-up adults by now. His observations were staggering: more than 90% of them were obese. And more than three fourth were either hypertensive, or had diabetes or had a heart attack, or had some combination of all these.
Dr Jones’s death and Simon’s efforts did not go in vain. Researchers like Dr Barker took up cudgels against this disease, and this new concept was called the thrifty phenotype hypothesis. According to this concept, babies born to malnourished mothers are likely to be underweight. And what is more, when these underweight babies would grow up, they were at a high risk of developing heart attacks, obesity, diabetes, hypertension and high cholesterol level. This was a paradigm shift in the understanding of diabetes and heart attacks. Since then low birth weight children have been shown to be at very high risk of diabetes and heart attacks, and this has even been shown in babies studied from Pune, India.”
I had finished telling a highly fictionalized account of the low birth weight theory of diabetes. I was not sure whether my audience had understood a word. At that point, Rohan asked, “ How exactly do people born small get diabetes and therefore heart disease when they grow up? Have scientists found out how this happens? ”
I was happy that people were still listening to this yarn. I replied, “ Yes, of course. Subjects with a low birth weight are at risk of diabetes because their pancreas has been deprived of nutrition during their mother’s pregnancy. This nutritionally deprived pancreas cannot produce enough insulin. As you know, insulin is a hormone that can control blood glucose and when the body is deprived of enough insulin, diabetes eventually occurs”
“ What about very fat babies, whose weight at birth is 5 or 6 kg? Are they not at risk of developing diabetes in future? Doesn’t obesity lead to diabetes?” asked Priya.
Another excellent question, I thought, and answered, “ You are right. Excess fat makes the body resistant to insulin. If insulin cannot act properly, diabetes ensues. Thus very thin, as well as very fat babies are at high risk of developing diabetes when they grow up. A birth weight of about 2 to 4 kgs is ideal. However, these are all hypotheses, and have never been conclusively proven. And I caution you: don’t bother to do repeated ultrasounds on your baby to find out its size. Theories are theories, and life is life! However, if research establishes this theory as fact- we will have a new tool of preventing diabetes, obesity and heart attacks. A tool that begins before the very beginning, indeed, even before birth: a method that could be called primordial prevention, or even, interventional fetal programming in the years to come ”
As we dispersed at night to our respective rooms, the young couple thanked me for the interesting story, for it made more sense to them at this time of their lives, as they were expecting to become parents soon. As everyone left, my wife and me decided to take a walk into the forest.
A few kilometers away, we spotted a herd of deer drinking water from a moonlit lake. The lake, perched on a mountain top, looked iridescent in the reflected moonlight. We saw the swarming deer, some sauntering slowly, some leaping gracefully and others running majestically on the banks. I could even spot a few baby deer, cuddling up to their parents. Did all this birth weight theory make any difference to the world? Did all these deer even know about diabetes? Who took care of them? Are scientists and researchers devoting their lives to chase esoteric and irrelevant hypothesis? Though the answer will probably never be known as long as science exists, the question on whether science should exist is always worth an ask!
(The author clarifies that the entire story is fiction. The social, political and economic aspects described are all part of this work of fiction. However, the scientific aspects, the theory called the “thrifty phenotype”, the links between birth weight and diabetes, as well as the case of the scientific report from Pune are all based on fact. Any resemblance to any other person or event, - including any resemblance of the narrator to the author himself- is completely coincidental! )
Priya, just 24 years old, was 5 months pregnant. She was justifiably anxious, and endearingly excited at the prospect of motherhood. During these days of leisure, the evenings were spent on telling and retelling horror stories. Usually, I was asked to narrate one, given my interest in the occult and the supernatural. The dark, mountainous, forestry and the night made a perfect ambience for this.
Today, however, Rohan and Priya wanted a different story from me. Priya had been reading about pregnancy on the internet, and was surprised to find that the baby got programmed in the mother’s womb. And this programming, she read, could determine almost every aspect of the baby’s health. She was excited, and wanted to know more. And like a fool, I had promised to tell her the story behind all this, only to realize later what a difficult task it would be to explain these things to a non-medical person.
“ A dark, dark concept indeed!” mused Rohan, sipping away at his drink, “ Who on earth would have thought that the mothers womb would set the tone for a lifetime? Come, come, you must tell us this story..”
Even the cloudy night broke into a sweet, expectant drizzle, as if the clouds could wait no more to hear my story. I decided to do an impromptu dramatization. I decided to throw away those hard facts and focus on telling the tale. I decided to enjoy myself in creating this story of part-fact, part fiction. I began ..
“ Almost a century ago, Britain had been suffering from the throngs of the Industrial Revolution. The economy was at an all-time low, and the middle classes in Britain were starving. The Renaissance had come and gone, but the Da Vincis and Michelangelos could hardly feed the world. Sandwiched between two World Wars, Britain’s poor were the most affected. Great Britain was not so great anymore. And the pangs were most acutely felt in Southampton and the nearby areas. Workers in steel mines, coalfields and related industry worked hard.
These workers would work for very little wages, sometimes running into only a few pence. After working for over 15 hours in a day, they would have little time for anything afterwards. They would brawl in the Inns, drink beer till their heads swam and then slept till their next shifts. The women were poorly structured, and looked starved and malnourished. At about that time, Dr Jones (name not changed as the existence of this doctor is purely fictious, I clarify!), a young doctor working tirelessly in for the miners noticed a thing or two about the pregnant women there. The women looked starved,. And when they became pregnant, their eyes took on a deathly pallor that bespoke of malnutrition. Dr Jones had dedicated his life to these miners and their families. He could not help noticing how he and his family too- just because of the heavy poverty that had descended on the times- had started looking as unhealthy as the miners themselves.
And when Dr Jones’s wife, young bonny lass of all but 24 years ( Priya Shuddered) delivered, Dr Jones was stunned to find out that the baby was only 1.3 kgs. Dr Jones checked the records…1.5 kg, 2 kg, 1.3kg, 1 kg, 900 g… he found that not a single child born in the area had an adequate birth weight of 2.5 kgs. For the next one year, Dr Jones would tirelessly collect the names and addresses of all the little babies that were born in the area. His clinic was filled with records of babies, their weights, their parents weights etc. Dr Jones was sure it was nothing to do with smoke or the coal. The low birth weight had everything to do with poverty, lack of food and maternal malnutrition. However, Dr Jones could hardly finish his work. He was stuck with pneumoconiosis, a lung disease that people exposed to coal mines got. One day he coughed out a few liters of blood and breathed his last. His clinic was temporarily shut down…”
I paused, in a typical storyteller style. Indeed, I was feeling guilty for having made up such a story. The story was, of course, based on fact, but the characters were completely fictitious! I paused to look at my audience. Their faces glowed in the light of the fireplace by the verandah. Their faces were eager, rapt with attention. Encouraged, I decided to take the plunge into a second odyssey of fiction. I continued.
“ The place was the same, but the year was 1970 (or was it 1962?). Britain had changed. Riding on the success of World War II and on the fiery speeches of Churchill, and spurred no doubt by Britains closeness to America, England was on a roll. Having woken from its Colonialist dream, the economy was booming. The stock indices were rising, manufacturing was on the increase and people were getting richer. There was plenty to eat and drink all around. In Herefordshire, and other areas near Southampton, a new disease was on the rise. People would eventually call it lifestyle diseases a decade later, and in 1988, it would be called Syndrome X. Simply put, people were getting Syndrome X, which was a constellation of obesity, diabetes, hypertension, high cholesterol. And this syndrome X eventually led to heart attacks.
Back in the areas where Dr Jones had set up his clinic, things were different. There were no coal miners, but people of new-found wealth. People were spending, children were eating, television was “in”. The situation is quite similar to India, with its newfound wealth today. Next to Dr Jones’ now-shut-down clinic was now a huge, modern, county hospital, with lush gardens and a smart-tiled roofs and floors. The hospital offered stat-of-the art facilities for the local community. The patients walking in no longer had tuberculosis or lung disease, but instead, died of diabetes, hypertension and heart attacks. The old and dead Dr Jones’ son Simon was now working there as a physician. He, like his father had an intuitive mind, and noticed a very odd thing. The people who were getting diabetes and hypertension and heart attacks were all children born to the miners of the city. Their wealth had grown, but Simon could see that the diseases went beyond the simple explanation of prosperity-induced diseases. Simon remembered his mother saying something about his father having made a list.
One night, Simon sought out Dr Jones office and traced out all the names of the children born to miners- the children with low birth weight, whose addresses the old Dr Jones had so diligently recorded just before his death.
Simon traced out and tested each and everyone of the low birth weight babies, who were all grown-up adults by now. His observations were staggering: more than 90% of them were obese. And more than three fourth were either hypertensive, or had diabetes or had a heart attack, or had some combination of all these.
Dr Jones’s death and Simon’s efforts did not go in vain. Researchers like Dr Barker took up cudgels against this disease, and this new concept was called the thrifty phenotype hypothesis. According to this concept, babies born to malnourished mothers are likely to be underweight. And what is more, when these underweight babies would grow up, they were at a high risk of developing heart attacks, obesity, diabetes, hypertension and high cholesterol level. This was a paradigm shift in the understanding of diabetes and heart attacks. Since then low birth weight children have been shown to be at very high risk of diabetes and heart attacks, and this has even been shown in babies studied from Pune, India.”
I had finished telling a highly fictionalized account of the low birth weight theory of diabetes. I was not sure whether my audience had understood a word. At that point, Rohan asked, “ How exactly do people born small get diabetes and therefore heart disease when they grow up? Have scientists found out how this happens? ”
I was happy that people were still listening to this yarn. I replied, “ Yes, of course. Subjects with a low birth weight are at risk of diabetes because their pancreas has been deprived of nutrition during their mother’s pregnancy. This nutritionally deprived pancreas cannot produce enough insulin. As you know, insulin is a hormone that can control blood glucose and when the body is deprived of enough insulin, diabetes eventually occurs”
“ What about very fat babies, whose weight at birth is 5 or 6 kg? Are they not at risk of developing diabetes in future? Doesn’t obesity lead to diabetes?” asked Priya.
Another excellent question, I thought, and answered, “ You are right. Excess fat makes the body resistant to insulin. If insulin cannot act properly, diabetes ensues. Thus very thin, as well as very fat babies are at high risk of developing diabetes when they grow up. A birth weight of about 2 to 4 kgs is ideal. However, these are all hypotheses, and have never been conclusively proven. And I caution you: don’t bother to do repeated ultrasounds on your baby to find out its size. Theories are theories, and life is life! However, if research establishes this theory as fact- we will have a new tool of preventing diabetes, obesity and heart attacks. A tool that begins before the very beginning, indeed, even before birth: a method that could be called primordial prevention, or even, interventional fetal programming in the years to come ”
As we dispersed at night to our respective rooms, the young couple thanked me for the interesting story, for it made more sense to them at this time of their lives, as they were expecting to become parents soon. As everyone left, my wife and me decided to take a walk into the forest.
A few kilometers away, we spotted a herd of deer drinking water from a moonlit lake. The lake, perched on a mountain top, looked iridescent in the reflected moonlight. We saw the swarming deer, some sauntering slowly, some leaping gracefully and others running majestically on the banks. I could even spot a few baby deer, cuddling up to their parents. Did all this birth weight theory make any difference to the world? Did all these deer even know about diabetes? Who took care of them? Are scientists and researchers devoting their lives to chase esoteric and irrelevant hypothesis? Though the answer will probably never be known as long as science exists, the question on whether science should exist is always worth an ask!
(The author clarifies that the entire story is fiction. The social, political and economic aspects described are all part of this work of fiction. However, the scientific aspects, the theory called the “thrifty phenotype”, the links between birth weight and diabetes, as well as the case of the scientific report from Pune are all based on fact. Any resemblance to any other person or event, - including any resemblance of the narrator to the author himself- is completely coincidental! )
5 comments:
Niice, vairy niice. Easy to get carried away and accept the night walk a few kilometres into the forest ;) Wonderful start, doktor u.
ninukku kore samayam undallo mone. Great work unni
The poor innocent foetus has a hard price to pay for the ignorance of the thoughtless mother.Wake up, endocrinologists, come to their rescue!!- Renu
Elegant writing, Unni.
We could perhaps put together a NEAT menu, each item with proportionate bonus points allotted, that people can choose from in order to increase their expenditure while at work, wherever they are at.
Yes, Rajeev I think this is a good idea.
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